Nursing Elites

1. A 15-year-old client with type 1 diabetes presents to the clinic for a routine follow-up. The nurse notes that the client’s hemoglobin A1c is 10%. What should the nurse include in the plan of care?

• A. Increase the frequency of self-monitoring of blood glucose.
• B. Discuss dietary changes to reduce carbohydrate intake.
• C. Review the client’s insulin administration technique.
• D. All of the above

Correct answer: D

Rationale: A hemoglobin A1c of 10% indicates poor blood glucose control, reflecting an average blood sugar level over the past 2-3 months. To improve control, the plan of care should be comprehensive. Increasing the frequency of self-monitoring of blood glucose helps track changes in blood sugar levels. Discussing dietary changes to reduce carbohydrate intake can aid in better blood sugar management. Reviewing the client’s insulin administration technique ensures proper medication dosing. Therefore, all the options (increasing monitoring, discussing dietary changes, and reviewing insulin administration) are essential components of the plan of care to address the client's poor blood glucose control. The correct answer is D because all these interventions are crucial for managing the client's condition effectively. Choices A, B, and C individually address different aspects of diabetes management and are all necessary in this scenario.

2. When developing a behavior modification program for an extremely aggressive 10-year-old boy, what should the nurse do first?

• A. Identify what activities, foods, and toys the child enjoys
• B. Assess the child's previous reactions to punishment
• C. Offer the child positive feedback
• D. Involve other children on the unit in describing the token system

Correct answer: A

Rationale: The first step in developing a behavior modification program for an extremely aggressive 10-year-old boy is to identify what activities, foods, and toys the child enjoys. Understanding the child's motivations is crucial in creating an effective behavior modification plan tailored to his interests and preferences, which can help in positively reinforcing desired behaviors.

3. What is the recommended analgesia for preparing a school-age child for a lumbar puncture (LP)?

• A. Ondansetron (Zofran) 4 mg / 5 ml PO TID.
• B. Codeine 10 mg PO 30 minutes before the procedure.
• C. A transdermal fentanyl (Duragesic) patch immediately before the procedure.
• D. EMLA (eutectic mixtures of local anesthetics) 2.5 hours before the procedure.

Correct answer: D

Rationale: For a lumbar puncture in a school-age child, EMLA cream should be applied 2.5 hours before the procedure. EMLA is commonly used to numb the skin, reducing pain and discomfort for the child during the procedure. Choices A, B, and C are incorrect because ondansetron is an antiemetic, codeine is an opioid analgesic that may not be suitable for children, and transdermal fentanyl is a strong opioid that is not typically used for local anesthesia in children undergoing lumbar puncture.

4. What is the priority action for a 2-year-old child with croup presenting with a barking cough and stridor?

• A. Administer a corticosteroid
• B. Obtain a throat culture
• C. Administer nebulized epinephrine
• D. Place the child in an upright position

Correct answer: C

Rationale: The priority action for a 2-year-old child with croup and stridor is to administer nebulized epinephrine. Nebulized epinephrine helps reduce airway swelling, alleviate symptoms, and improve breathing by causing vasoconstriction and reducing upper airway edema. Administering a corticosteroid may be done but is not the priority in this scenario. Obtaining a throat culture is not necessary for the immediate management of croup. Placing the child in an upright position can aid in breathing but is not the priority action when the child is presenting with stridor.

5. A 4-month-old girl is brought to the clinic by her mother because she has had a cold for 2 to 3 days and woke up this morning with a hacking cough and difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress?

• A. Bilateral bronchial breath sounds.
• B. Diaphragmatic respiration.
• C. A resting respiratory rate of 35 breaths per minute.
• D. Flaring of the nares.

Correct answer: D

Rationale: Flaring of the nares is a clinical sign of acute respiratory distress in infants. It indicates an increased effort to breathe and is a crucial finding that requires immediate attention, as it signifies the child is having difficulty breathing and may be in respiratory distress. Choices A, B, and C are incorrect. Bilateral bronchial breath sounds may be present in conditions like pneumonia but do not specifically indicate acute respiratory distress. Diaphragmatic respiration is a normal breathing pattern and not a sign of distress. A resting respiratory rate of 35 breaths per minute in a 4-month-old infant is within the expected range, so it does not necessarily indicate acute respiratory distress.

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